Effects of 12-week supervised treadmill training on spatio-temporal gait parameters in patients with claudication.

UNLABELLED: The purpose of the study was to evaluate selected temporal and spatial gait parameters in patients with intermittent claudication after completion of 12-week supervised treadmill walking training. The study included 36 patients (26 males and 10 females) aged: mean 64 (SD 7.7) with intermittent claudication. All patients were tested on treadmill (Gait Trainer, Biodex). Before the programme and after its completion, the following gait biomechanical parameters were tested: step length (cm), step cycle (cycle/s), leg support time (%), coefficient of step variation (%) as well as pain-free walking time (PFWT) and maximal walking time (MWT) were measured. Training was conducted in accordance with the current TASC II guidelines. After 12 weeks of training, patients showed significant change in gait biomechanics consisting in decreased frequency of step cycle (p < 0.05) and extended step length (p < 0.05). PFWT increased by 96% (p < 0.05). MWT increased by 100% (p < 0.05). After completing the training, patients' gait was more regular, which was expressed via statistically significant decrease of coefficient of variation (p < 0.05) for both legs. No statistically significant relation between the post-training improvement of PFWT and MWT and step length increase and decreased frequency of step cycle was observed (p > 0.05). IMPLICATIONS FOR REHABILITATION: Twelve-week treadmill walking training programme may lead to significant improvement of temporal and spatial gait parameters in patients with intermittent claudication. Twelve-week treadmill walking training programme may lead to significant improvement of pain-free walking time and maximum walking time in patients with intermittent claudication.

Effect of treadmill training on endothelial function and walking abilities in patients with peripheral arterial disease.

BACKGROUND: In this prospective study we evaluated the effects of treadmill training on patients' walking ability, as well as endothelial function, high-sensitivity C-reactive protein (hs-CRP), and fibrinogen concentration. METHODS: A total of 67 patients with stable intermittent claudication were included in a 12-week supervised training program. An observational follow-up period then lasted a mean of 37 weeks. Forty patients completed follow-up. Changes in blood pressure, flow-mediated dilatation (FMD), and treadmill walking performance expressed as maximal walking time (MWT) were assessed before and after the training program and during the follow-up period. Moreover, ankle/brachial index (ABI), plasma levels of hs-CRP, fibrinogen, as well as a lipid profile were assessed before and after the training program. RESULTS: Maximal walking time improved significantly after treadmill training by 90% (p<0.001) and after follow-up by 64% (p<0.001) in comparison to baseline. FMD values increased by 43% (p<0.001) after the training program, and by 29% (p=0.058) after follow-up, compared to baseline. We noticed a significant decrease in hs-CRP concentration (p=0.025) and an increase in ABI values (p=0.039) in response to the treadmill training program. No effect on lipid profile was observed. CONCLUSIONS: The 12-week treadmill training program prolonged the asymptomatic walking distance. The improvement in FMD indicates a systemic effect of the treadmill program on endothelial function. The supervised treadmill training provides an effective and safe treatment option in patients with PAD. The effects of unsupervised exercise during follow-up period after treadmill programs remain tentative and underestimated.

Comparison of two treadmill training programs on walking ability and endothelial function in intermittent claudication.

BACKGROUND: In this randomized trial we compared two treadmill trainings, based on exercises performed to moderate claudication pain vs pain-free training, with respect to their effects on walking ability and endothelial function. METHODS: A total of sixty patients with stable intermittent claudication were randomized to the pain-free treadmill training (repetitive intervals to onset of claudication pain) or moderate treadmill training (repetitive intervals to moderate claudication pain). In both groups exercises were performed 3 times a week for 3 months. Changes in flow mediated dilatation (FMD) and treadmill walking performance as well as plasma levels of C-reactive protein (hs-CRP) and fibrinogen were assessed before and after the program. RESULTS: Fifty-two patients completed the training program. Post-training maximal walking time was prolonged by 100% (p<0.001) vs 98% (p<0.001), and pain-free walking time by 120% (p<0.001) vs 93% (p<0.001) in the moderate training group as compared to the pain-free training group, respectively. FMD increased by 56% (p<0.001) in the moderate training group and by 36% (p<0.01) in the pain-free training group. No significant changes in the levels of hs-CRP and fibrinogen were seen after treadmill program in either group. CONCLUSIONS: Both pain-free treadmill training and the moderate treadmill training have similar efficacy on walking ability in patients with claudication. The improvement of post-training FMD indicates systemic effect of both treadmill programs on endothelial function. Both programs appear to be safe therapeutic modes, since none of them escalates the inflammation. Pain-free treadmill training seems useful and effective therapeutic option for patients with claudication.